Benign prostatic hyperplasia

Basal cell hyperplasia

This condition is a relatively rare morphological variant of benign prostatic hyperplasia. The pathological process is predominantly localized in the transition and peripheral zones of the organ.

From a clinical perspective, this variant has no specific differences—the disease runs an absolutely identical course to the classic form of BPH without forming unique symptoms.

Pathological anatomy and microscopic picture The diagnosis is established exclusively via histological examination. Microscopic examination reveals the following characteristic features:

• The parenchyma of the formed nodules is represented by small solid nests and tissue cords (unlike the glandular acini, cribriform, or papillary structures characteristic of other pathologies).
• The structures are composed of monomorphic dark cells belonging to the basal type.
• The cellular elements are distinguished by a relatively high nuclear-cytoplasmic ratio.

Differential diagnosis for this form of hyperplasia must necessarily be performed with classic BPH, prostate cancer, and prostatic intraepithelial neoplasia.

Prostatic intraepithelial neoplasia (PIN)

Prostatic intraepithelial neoplasia, frequently designated by the abbreviation PIN (PIN), is a focal proliferative process involving the lining of the acini. It is accompanied by progressively advancing atypia and marked polymorphism of secretory-luminal cells.

In medical literature, PIN may be found under several synonyms:

• Atypical primary hyperplasia;
• Large acinar atypical hyperplasia;
• Ductal-acinar dysplasia.

Epidemiology and clinical presentation Most frequently, this condition is diagnosed in patients over 60 years of age. A specific clinical picture is completely absent—the disease is asymptomatic and lacks characteristic manifestations, making morphological examination the key detection tool.

Classification and prognosis of PIN

The concept of PIN is a group term. Depending on the severity of morphological changes, the process is subdivided into two main forms:

1. Low-grade PIN—characterized as incipient or mild dysplasia of acinar epithelial cells.
2. High-grade PIN—includes moderate and severe dysplasia, up to the stage of in situ carcinoma (carcinoma in situ). Staining preparations with hematoxylin and eosin visualizes clear and pronounced changes in the glandular structure.

Prognostic significance Assessment of the grade of malignancy is critical for determining patient management tactics. High-grade prostatic intraepithelial neoplasia is considered an obligate precancerous condition. According to available data, this condition eventuates in invasive prostate cancer in 100% of cases over time.

Class and exam questions

What else to study on this topic

• Classic form of benign prostatic hyperplasia
• Differential diagnostic criteria for PIN and prostate cancer
• Histological features of carcinoma in situ in the prostate gland
• Assessment of the nuclear-cytoplasmic ratio in basal-type cells

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.